The National Health Service is, as all Americans know and fear, a
completely public "socialized medicine" system. It's dramatically
different from the US's patchwork system of private providers and
insurance companies.

My story isn't representative, of course. Healthcare delivery is
different in the UK depending on where you live and which doctors
and hospitals you use — just as it is in the US. But I've now
used both systems for about two decades each, so I feel I have a
pretty good handle on the main contrasts.

'THIS ROLLS ROYCE ISN'T MOVING FAST ENOUGH!'

A slow-moving vehicle for
healthcare.Rolls-Royce

In the UK, 93.4% within four hours is regarded as a huge failure
— the standard the NHS is supposed to meet is 95% of patients in
four hours. Americans might feel comforted by this. In the
US, an average of 95% of patients are seen within three hours,
according to the CDC. You can see more data
on this here.

That makes it sounds like American healthcare is faster, but
there is a statistical detail that is very important here: The
93.4% number for the NHS is for the complete treatment of all
patients arriving for emergency care. The 95% number for the
US is the average wait time for a patient to see a
doctor.

In other words, Americans get to see a doctor after a three-hour
wait. Brits will have seen a doctor and been treated within four
hours.

If you want quick emergency care, the UK is still the place to
be.

In the US, having sat in many an ER waiting room for hours at a
stretch, I can tell you the idea of a hospital seeing nearly 9
out of 10 patients in four hours would be regarded as a miracle.

Bear in mind that within that four-hour period the NHS doctors
are triaging patients: If you get hit by a bus, you're going to
see someone instantly. If you broke a finger because you fell
over while drunk at the pub, you're probably going to wait at the
back of the line. It's not like people are literally bleeding to
death while they wait for attention (although the British media
loves it when it finds individual cases where that has happened).

So my overall impression is that currently, the Brits' complaints
that the NHS isn't hitting that 95% mark is akin to saying, "This
Rolls Royce isn't moving fast enough!"

SHOW UP WHEN YOU'RE TOLD TO - OR ELSE

The first major difference from the patient's point of view is
what happens when you call your doctor for a routine appointment.
My specific health issue was that I thought I was going slightly
deaf, and wanted it checked out.

I'm a dual US/UK citizen, so I qualify for NHS treatment. Here's
what happened to me.

NHS workers hold placards
as they stand on a picket line demanding higher pay, outside St.
Thomas' Hospital in London on November 24.REUTERS/Andrew Winning

In America, you call your doctor and request an appointment when
it's convenient for you. They might ask you what's wrong with
you, presumably to make sure it's not something that requires
immediate treatment. But basically, it's first come, first
served, regardless of how important it is. Usually, you can pick
an appointment time that's convenient for you if it is not an
emergency.

In the UK, I was given an appointment whether I liked it
or not. I called and left a message. Within an hour or
two a nurse practitioner called me back and asked me a few
questions about my problem over the phone. (You've got to take
the call in a private place if you don't want your office mates
to hear.) Then they said: Come in at 9am on Thursday. There was
no choice over appointment times — the assumption is that if
you're ill, you're going to come to the doctor when they say.

At first I found this jarring. In America, I get to choose
whenI see the doctor! In Britain, I better show up
when I'm told. But the appointment came quickly, as the local
health authority in London has targets it needs to meet.
Ultimately, I saw the logic of it: This is a public health
system. It needs to manage its costs and services. If you're
really sick, you'll show up. If you only want to show up when
it's convenient for your schedule, then how sick are you, really?

AMERICA IS WORSE AT ON-THE-DAY CARE

Prime Minister David
Cameron visits a hospital patient to demonstrate his commitment
to the NHS.REUTERS/Neil
Hall

In America, I've always had a long wait to see my doctor. I have
read many a back issue of Newsweek in my primary care / general
practitioner (GP) doctor's office. I've sat there for an hour
playing with my phone while the doc sees patients in the order
they were booked.

In the UK, I showed up at 9am and was seen
instantly, at the Waterloo Health Centre. For an
American, this was bizarre: My butt barely touched the seat in
the waiting room before my name was called. Turns out my doc and
her staff are serious about patient scheduling.

This was one reason I became convinced that the NHS way of
scheduling is superior: You might not get the time or date that
you want, but once you're in, you get seen super-quick.

THE NHS ACTIVELY DISCOURAGES SOME PATIENTS - FOR GOOD REASON

The NHS actively discourages some types of
patients: Interestingly, NHS offices and hospitals have
posters up all over the place warning you not to show up at the
emergency room if you have a cold or the flu. They're actively
discouraging patients with minor ailments from seeking emergency
treatment, and trying to get them to see their regular doctors
instead. It's sensible — everyone knows that a vast amount of
hospital time and money is wasted treating people who are not an
emergency. And hospitals and doctor's surgery waiting rooms are a
hotbed of germs. But still, it's a culture shock to see a medical
institution put up signs that basically say, "go home, you
idiot!" in every waiting room.

The US never discourages patients from doing
anything. I've never seen any kind of public campaign to
persuade patients to apply some common sense before dropping
themselves off at an emergency room. The entire US pharmaceutical
industry is also dedicated to running ads encouraging people to
"go see your doctor" for even the most trivial of conditions.

They
wear the same scrubs, too.Chung
Sung-Jun/Getty Images

The treatment from my primary care GP was the same in the UK as
it was in the US. I've had great care from 95% of doctors I've
ever seen in both the US and the UK. Doctors are doctors. They're
mostly really nice and good at what they do. The system that pays
them doesn't seem to make them better or worse.

THERE IS BASICALLY NO PAPERWORK WITH THE NHS

There is a load of paperwork for patients in the
US. This is easily the worst aspect of US healthcare —
the billing paperwork. If you've ever had any health issue that
required more than a simple doctor visit, you will know that it
precipitates a seemingly never-ending series of forms, bills, and
letters. You can be paying bills months, years later. And it's
almost impossible to correct a billing error. It's stressful. I
developed an intense hatred for health insurance companies in the
US because of this.

There was close to zero paperwork in the NHS. I
filled in a form telling my doc who I was and where I lived, and
that was pretty much it. The only other paperwork I got was a
letter in the mail reminding me of my next appointment. They sent
me a text reminder, too, which no American doc has ever done. It
was incredibly refreshing.

THE STANDARD OF CARE IS THE SAME

Jim Edwards / BI

So, was I going deaf? Maybe. Maybe not. I'd lost my sense of
balance in summer 2014, which an American doctor had diagnosed as
Benign Paroxysmal Positional Vertigo. It's a condition of the
inner ear. It made my body feel slightly drunk and clumsy even
though I am completely sober.

The US doc told me there is no treatment and it goes away
on its own, mostly. A lot of people get it, apparently.
I was managing fine and it doesn't bother me, anyway.

The UK doc told me the same thing, but also suggested
I might have Meniere's Disease, and wanted to send
me to a specialist to get it checked out. Meniere's isn't really
a disease, it's just a collection of symptoms: dizziness, hearing
loss and a ringing in the ears. Again, there is no treatment. But
it's rare.

This freaked me out a little bit. I was used to the US system
which is heavily "defensive." Doctors tend to over-treat patients
because they get sued if they miss something. They also get paid
more money for doing more work. Yet it was the NHS doctor that
suggested extra treatment.

It was going to be free — so I said yes!

A LONG WAIT FOR NHS TREATMENT ...

I then made an appointment with a specialist at the Guy's and St
Thomas' Hospital in London.

St. Thomas' hospital in
London, which I can see from my kitchen.Jim Edwards / BI

In the US, I've always been able to see a specialist within a few
days. Score one for America.

In the UK, they said "we'll see you in January."
It was late November, six weeks or more away. This was a shock. I
was going deaf now — not in six weeks! What the hell?!

NHS waiting times are a real thing, it turns out. I comforted
myself with the assumption that the staff had made a decision
that my condition was likely not health-threatening, and had
moved me to the back of the line. It was frustrating. Ultimately,
I also needed to change my appointment because I had to leave the
country on business, and this was quite difficult to do. I had to
call a few times, basically to catch the hospital booking staff
at the right time of day, in order to do it. I wished Guy's and
St. Thomas' had an online system for this, but they don't — just
a bunch of people answering phones, most of whom don't have
access to the right appointment schedule.

It was that appointment system again: You're booked in according
to their priority, not yours. The big lesson
with the NHS is, it's a lot easier to just show up when you're
told.

OLD PEOPLE IN BRITAIN ARE REALLY RUDE

In the US, I expect to wait up to an hour in the
specialist's waiting room on the day of my appointment.
I often wonder if Time and Newsweek were such big magazines in
the US because they're needed for bored patients in American
doctors' waiting rooms. Nothing ever happens promptly on the day
in US healthcare, as far as I can tell.

In the NHS, again, I waited only a couple of
minutes. Credit to the staff at St. Thomas, they are
cranking through their patients.

These are not the old
people I'm referring to.sharman/flickr

On two occasions I noticed old people complaining angrily (and
rudely) to the office staff that they had been made to wait 15 or
20 minutes to see their doctor. As an American, I almost laughed
out loud. Fifteen minutes to see a free doctor! This Rolls
Royce isn't moving fast enough! I asked a British friend —
someone who has ongoing health issues and sees a lot of doctors —
if old people complaining like this was common. Turns out, it is.
Old British people love to complain to NHS staff if they wait
more than 1o minutes. Everyone just expects their appointments to
be exactly on time.

Again, the NHS care was great. I saw two different doctors within
an hour, one for testing and one for diagnosing. A third admin
staffer was coordinating the lists so there was no doctor
downtime. It was like being in a highly efficient factory. It
looked like hard work. I could tell that one of my doctors was
not interested in chatting. She treated me, and wanted me out the
door. There was a bunch of patients behind me, after all. In
America, docs seem to be happy to chat as long as you want — and
you can tell that extra couple of minutes with each patient
creates long delays as the day wears on.

The good news: I am not going deaf! I have
great hearing, it turns out. They even showed me a chart
of it. But the tinnitus — ringing in my ears that started years
ago because I used to go to a lot of punk rock gigs in my youth —
has gotten worse, making me feel more deaf.

The UK NHS specialist said she was 99% sure there was nothing
wrong with me, or at least nothing that could be treated, but she
recommended an MRI to see what the condition of my inner ears is
like. This was reassuring. In no way was my treatment rationed or
denied, the way Americans fear. It was just the same as in the
US, with the same number of docs and the same level of high-tech
equipment.

THE COST TO THE PATIENT IS MUCH CHEAPER IN THE UK, OBVIOUSLY

So how much did all this NHS care cost me? £0. Nothing. Zero. I
paid not a penny for some top-notch healthcare. There is no such
thing as a "free," of course, but the per-capita cost of
healthcare in the UK (paid by the government via tax collections)
is generally lower than the US,
according to the World Health Organization. Americans spend
$8,362 per capita on healthcare annually, the Brits spend
$3,480. Here is a breakdown:

SORRY AMERICA, BUT NHS TREATMENT REALLY IS BETTER OVER ALL

The bottom line: I prefer the NHS to the
American private system. It's a little more inconvenient in terms
of appointment times, but due to the fact that it is free, has no
paperwork, and the treatment on the day is super-fast, the NHS
wins. That Rolls Royce is moving at a pretty decent clip.

And, of course, there is the small matter of the fact that the
NHS covers everyone equally, whereas Americans get care based on
their ability to pay, leaving
tens of millions with only minimal access to care. (Obamacare
is changing that, but it's leagues behind the NHS if you're
comparing them by the standard of universal full-service
coverage.)

Americans think they have the best healthcare in the
world. Take it from me, a fellow American: They don't.